Concerns about safety and infection control in Royal Oldham Hospital's urgent and emergency services
Inspectors say the quality of care in its urgent and emergency services requires improvement.
The Royal Oldham Hospital has been told to improve the quality of care in its urgent and emergency services.
An inspection by the Care Quality Commission (CQC) in November has seen the rating of those facilities move from Good to Requires Improvement overall.
The unannounced and focused inspection took place as part of the organisation's winter pressures programme but was also prompted in part following concerns from staff and members of the public about safety and quality.
Following the inspection, the CQC told the trust to take action due to concerns around the potential significant risk of harm to patients. This included issues around infection, prevention and control, performance, training and patient flow through the department.
CQC’s deputy chief inspector for the north, Ann Ford, said:
“During our inspection in November, we could see that staff at The Royal Oldham Hospital were working hard to provide care to patients in very challenging conditions, when the North West as a whole was experiencing significant levels of COVID-19 related pressure.
“Given the pressure the trust were under, the decision to inspect during this period was a difficult one. However, both staff and patients told us they were concerned about the safety of care being delivered in the urgent and emergency department and we had a duty to inspect to support the trust in knowing where to make improvements.
“Upon inspection we were concerned by some of the infection prevention and control practices we saw in the department. Although the trust had systems and processes in place to reduce and manage the risk of infection, staff did not always follow these in order to protect patients, themselves and others from COVID-19 transmission.
“We also found that while most staff training was up to date, not all staff had received training on life support and safeguarding. The trust must ensure that all staff in this service have the appropriate qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment they deserve. However inspectors did see that staff worked together as a team and felt well supported.
“We reported our findings to the trust leadership team, who took immediate action to address some of the concerns raised. They also provided further details of their continuing plans to improve the safety and quality of medical care services.
“We will continue to monitor the trust and will return to check on the progress of improvements.”
The CQC inspection team identified concerns which included:
• The service did not always control infection risk well - staff did not always maintain social distancing between patients or themselves, staff workstations were close together which limited staff ability to socially distance when updating patient records and staff, patients and ambulance crews were not always able to maintain social distancing in the corridors.
• The design and use of facilities, premises, and signage did not always keep people safe. Not all areas of the service were appropriate for the care and treatment provided.
• Although the department usually had enough registered nurses on duty on most shifts, there were not enough health care support workers and medical staffing levels were reliant on locum and agency staff.
• Ambulance handover times, waiting times from referral to treatment and arrangements to admit, treat and discharge patients, 12-hour trolley waits, and total time in the department were not in line with national standards or trust internal targets.
Libby McManus, Group Chief Nursing Officer & Director of Infection Prevention and Control for the Northern Care Alliance NHS Group, which runs The Royal Oldham Hospital, said:
“On the day the CQC inspected our Emergency Department in November last year, the inspection team saw some infection control practice which is neither acceptable nor our usual high standard and for this we are sorry to our patients and public.
“We pride ourselves on the care we provide and take the safety of our patients and staff extremely seriously. We did not wait for this report to be published. I want to reassure those who depend on our services that immediate and decisive action was taken to address the areas of improvement required. We continue to monitor and manage the small yet significant detail of all our practice.
“Overall the CQC found that the Emergency Department at Oldham was ‘well led’ and scored highly in this area, rated overall as ‘Good.’ However, in the CQC’s ‘safe and responsive’ category the service and department was rated as ‘Requires Improvement.’
“Our teams have used this report to make the necessary improvements and share learning across our organisation. We are committed to listening to our patients and staff when it comes to continuing to improve the safety and quality of care in our hospitals. I am encouraged that the CQC found that our staff felt respected, supported and valued and had an open culture where they felt they could raise any concerns. We continue to do everything we can to support our people.
“The CQC’s inspection has highlighted the significant challenges and demands our staff and staff right across the NHS are under in dealing with not only high attendances, but also the impact the pandemic is having on our staff and services. We remain focused on protecting and separating Covid patients, avoiding overcrowding in A&E, and dealing with the challenge in the reduction in bed capacity due to the need for additional Covid-19 beds.
“Our work with our local health and care partners in primary care and in social care continues to focus on improving how patients flow in and out of our hospital. We must support people in the community to avoid being admitted to hospital wherever possible.
“People should continue to feel safe and confident in accessing care and treatment at our hospital services.”
The inspection team also found some good practice which included:
• Staff completed and updated risk assessments for each patient and removed or minimised risks. Staff identified and quickly acted upon patients at risk of deterioration.
• Staff felt respected, supported and valued and had an open culture where they felt they could raise concerns without fear.
• The service used systems and processes to safely prescribe, administer, record and store medicines in line with their policy. Staff monitored patients regularly for pain and provided pain relief quickly.
Full details of the inspection can be read HERE.